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Infecciologia
NOVEMBRO/DEZEMBRO 2010
Lu VH, Goldberg I, Lu CY.
Use of glaucoma medications: state of the science and directions for observational research.
Am J Ophthalmol 2010; 150 (4): 569-574.
PURPOSE: To summarize observational studies that focus on the use of glaucoma medications and to identify gaps in knowledge to guide future investigation.
DESIGN: Literature study.
METHODS: We searched the electronic databases MEDLINE, EMBASE, and PubMed for English language articles published through December 2009 using the search terms physician's practice patterns, drug prescriptions, pharmaceutical services, medication adherence, ophthalmology, glaucoma, and ophthalmic solutions. We categorized studies by areas of focus and extracted and summarized key features: study population, data sources, and main findings.
RESULTS: We identified 2224 articles by the search. Fifty-five described glaucoma medication use using large databases. Predominant areas of focus were: trends in prescription choices (n = 13); adherence, persistence, or both (n = 31); rational use of medications (n = 9); and policy-related issues (n = 2). Over the last decade, use of β-blockers and miotics has decreased substantially, whereas new agents, particularly prostaglandin analogs, have become more popular. Nonadherence was an issue in more than 25% of patients. A significant proportion of patients with comorbidities, contraindications, or both had received topical β-blockers.
CONCLUSIONS: To date, most studies have focused on adherence to glaucoma medications and changes in treatment choices. Major gaps in knowledge include prescribing patterns by prescriber specialty (ophthalmologists, primary care physicians, and optometrists), medication-related problems, and subsequent adverse health outcomes. Well-designed longitudinal observational studies addressing these gaps are warranted to improve patient safety.
Ness PJ, Mamalis N, Werner L, Maddula S, Davis DK, Donnenfeld ED, Olson RJ.
An anterior chamber toxicity study evaluating Besivance, AzaSite, and Ciprofloxacin.
Am J Ophthalmol 2010; 150 (4): 498-504.
PURPOSE: We determined whether Besivance (Bausch & Lomb), AzaSite (Inspire Pharmaceuticals, Inc; both with DuraSite bioadhesive [InSite Vision, Inc]) and ciprofloxacin are toxic inside the anterior chamber.
DESIGN: Randomized, masked, placebo-controlled animal study.
METHODS: Twenty New Zealand white rabbits (40 eyes) were randomized to 1 of 4 study groups: Besivance, AzaSite, ciprofloxacin, and balanced salt solution. Each eye was injected with 0.1 mL of the study medication. Clinical slit-lamp examinations were conducted at 24 and 48 hours after injection. All rabbits then were killed and all eyes were enucleated. We randomized eyes to either corneal vital staining or histopathologic examination. The main outcome measures were clinical and pathologic signs of toxicity.
RESULTS: The 2 DuraSite-based study groups (Besivance and AzaSite) showed clinically and pathologically significant differences when compared with the ciprofloxacin and balanced salt solution groups. Besivance and AzaSite eyes exhibited significantly similar and severe clinical damage, including severe corneal edema. Ciprofloxacin and balanced salt solution eyes appeared very similar and had only mild conjunctival injection and limbal vascularity. Vital staining and histopathologic evaluation revealed glaucomatous and toxic damage in eyes given DuraSite-based medications, whereas non-DuraSite groups showed minimal changes.
CONCLUSIONS: DuraSite blocks the trabecular meshwork and may be additionally toxic when introduced as a large bolus. Until the safety of these medications is established with further studies using smaller injected volumes, we recommend placement of a suture over a clear corneal wound if DuraSite-based medications are used.
Shin JH, Lee HB, Park HY.
Comparison of the effects of fourth-generation fluoroquinolones on epithelial healing after photorefractive keratectomy.
Cornea 2010; 29 (11): 1236-1240.
PURPOSE: To compare the effects of fluoroquinolones gatifloxacin and moxifloxacin used for antimicrobial prophylaxis after photorefractive keratectomy (PRK) on epithelial healing.
METHODS: Forty-four patients randomly received the prophylactic antibiotics gatifloxacin (Gatiflo; 0.3% gatifloxacin ophthalmic solution, Handok, Chungbuk, Korea, no preservative) in 1 eye and moxifloxacin (Vigamox; 0.5% moxifloxacin hydrochloride ophthalmic solution, Alcon Laboratories, Inc, Fort Worth, TX, no preservative) in the fellow eye after PRK. Corneal epithelium was circumferentially removed along a 7-mm zone mark. After PRK, all patients used topical antibiotics 4 times a day until the epithelium healed completely. Starting from postoperative day 1, epithelial healing times and defect sizes were recorded by slit-lamp examination and anterior segment photography. Postoperative pain and discomfort induced by the eyedrops were recorded. Additionally, therapeutic contact lenses were cultured to assess the antibacterial efficacy of fluoroquinolones.
RESULTS: The mean epithelial healing times after PRK were similar for the 2 groups: 2.97 ± 0.41 days for gatifloxacin and 2.95 ± 0.48 days for moxifloxacin (P = 0.81). There was no statistically significant difference in mean defect size on each postoperative day between the treatment groups. There was no difference in postoperative pain and discomfort. No statistically significant differences were observed between eyes treated with gatifloxacin and moxifloxacin in terms of uncorrected visual acuity or best-corrected visual acuity at 3 months postoperatively.
CONCLUSION: No significant differences were found in the effects of the preservative-free fourth-generation fluoroquinolones gatifloxacin and moxifloxacin on epithelial healing after PRK.
Elsahn AF, Yildiz EH, Jungkind DL, Abdalla YF, Erdurmus M, Cremona FA, Rapuano CJ, Hammersmith KM, Cohen EJ.
In vitro susceptibility patterns of methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus corneal isolates to antibiotics.
Cornea 2010; 29 (10): 1131-1135.
PURPOSE: To determine the in vitro susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) isolates to various antibiotics.
METHODS: All cases of bacterial keratitis caused by Staphylococcus species during 2006 and 2007 were identified. The isolates were divided according to species and susceptibility to methicillin into 4 groups: methicillin-susceptible S. aureus, methicillin-susceptible coagulase-negative Staphylococcus, MRSA, and MRCNS. Routine susceptibility testing for Staphylococcus species to methicillin and 19 other antibiotics was performed using the MicroScan POS Breakpoint Combo Panel Type 20.
RESULTS: One hundred fifty-seven isolates were identified. Forty isolates were S. aureus, including 21 MRSA, and 117 isolates were coagulase-negative Staphylococcus, including 29 MRCNS. All MRSA isolates were susceptible to gentamicin, linezolid, rifampin, tetracycline, and vancomycin and were resistant to penicillin, cefazolin, cefepime, azithromycin, erythromycin, and ofloxacin. Ninety percent of MRSA isolates were resistant to fourth-generation fluoroquinolones. All MRCNS isolates were susceptible to vancomycin, chloramphenicol, linezolid, and rifampin and were resistant to penicillin, cefazolin, cefepime, and azithromycin. Sixty-five percent of the MRCNS isolates were susceptible to fourth-generation fluoroquinolones and gentamicin.
CONCLUSIONS: All MRSA and MRCNS isolates were sensitive to vancomycin, linezolid, and rifampin. MRSA isolates were generally sensitive to gentamicin and tetracycline and resistant to fourth-generation fluoroquinolones. MRCNS isolates were not consistently sensitive to gentamicin, tetracycline, or fourth-generation fluoroquinolones.
Porter LF, Khan RU, Hannan A, Kelly SP.
MRSA and cataract surgery – reflections for practice.
Clinical Ophthalmology 2010; 4: 1223–1227.
Introduction: Postoperative bacterial endophthalmitis is a devastating complication of cataract surgery. Methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis is rare. Recent debate over MRSA screening in United Kingdom (UK) National Health Service (NHS) hospital services has implications for cataract patients and ophthalmology services.
Aims: To discuss issues for clinical practice as based on reflective experience at a UK district general NHS hospital in relation to care of MRSA-positive cataract patients.
Methods: Retrospective case series and reflective practice.
Results: Three cases presented highlight practice points around cataract patients colonized with MRSA. Known or determined MRSA-colonized patients should be treated with anti-microbial agents at time of cataract surgery known to be active against MRSA. Preventative treatment with intracameral vancomycin or intravenous teicoplanin alongside appropriate topical treatments may be of merit. Importantly fluoroquinolones, often prescribed by cataract surgeons, may have a selective effect favoring the proliferation of MRSA.
Conclusion: MRSA screening may cause unnecessary delays in cataract care and may represent a patient safety concern in its own right. Patients colonized with MRSA may safely undergo cataract surgery provided there is no evidence of periorbital infection and provided appropriate infection control and antibiotic prophylaxis measures are used. The well-prepared cataract surgeon needs to be aware of developments in infection control and should liaise with local clinical microbiology colleagues in relation to bacterial resistance to antibiotics.
Keywords: methicillin-resistant Staphylococcus aureus (MRSA), endophthalmitis, screening
Ayaki M, Iwasawa A, Soda M, Yaguchi S, Koide R.
Cytotoxicity of five fluoroquinolone and two nonsteroidal anti-inflammatory benzalkonium chloride-free ophthalmic solutions in four corneoconjunctival cell lines.
Clin Ophthalmol. 2010; 4: 1019-1024.
Abstract
PURPOSE: Epithelial disorders after eye surgery can result in visual deterioration and patient discomfort. Such disorders may be caused by drug toxicity. In the present study, we evaluated the toxicity of ophthalmic solutions, with or without benzalkonium chloride (BAK) as the preservative, used for postoperative care.
METHODS: A range of commercially available antibiotic and anti-inflammatory ophthalmic solutions used postoperatively (ie, levofloxacin, moxifloxacin, gatifloxacin, norfloxacin, tosufloxacin, dibekacin, cefmenoxime, diclofenac, bromfenac, pranoprofen, betamethasone, and fluoromethorone) were assessed in three corneal cell lines and one conjunctival cell line. All antibiotic solutions were BAK free. Cell viability was determined with the 3-(4,5-dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay after cells had been exposed to the drugs for 48 h. The effects of preservatives on cell viability were also determined. Toxicity was compared using the cell viability score (CVS).
RESULTS: Based on results of the MTT assay and CVS, the order of cell viability after exposure to the antibiotic solutions was cefmenoxime ≥ tosufloxicin ≥ dibekacin ≥ levofloxacin ≥ norfloxacin = gatifloxacin = moxifloxacin. For the anti-inflammatory solutions, the order of cell viability was betamethasone ≥ betamethasone + fradiomycin > preservative-free diclofenac ≥ preservative-free bromfenac >> 0.02% fluoromethorone ≥ 0.1% fluoromethorone = diclofenac + preservative = bromfenac + preservative = pranoprofen. The anti-inflammatory drugs were more toxic than the antibiotics. The toxicity of antibiotic drugs against ocular surface cells was dependent on the pharmaceutical components of the solution, whereas that of the anti-inflammatory drugs was dependent on both the pharmaceutical components and the preservatives.
CONCLUSION: Postoperative drug-induced epitheliopathy may be caused primarily by anti-inflammatory drugs. CVS is useful in comparing the cytotoxicity of different drugs.
Frenkel REP, Frenkel SA, La M, Frenkel MPC, Reyes A
A protocol for the retina surgeon’s safe initial
Clinical Ophthalmology 2010: 4; 1279–1285.
Purpose: To determine the safety of a surgeon’s initial consecutive intravitreal injections using a specific protocol and to review the complications that may be attributed to the injection procedure.
Design: A retrospective chart review.
Participants: Fifty-nine patients (30 females, 29 males) received intravitreal injections of pegaptanib, bevacizumab, or ranibizumab as part of their treatment for neovascular age-related macular degeneration. The average patient age was 80 years. Twenty-two patients were diagnosed with or suspected of having glaucoma. Each patient received an average of 5.8 injections.
Methods: The charts of 59 patients who received a total of 345 intravitreal injections (104 pegaptanib, 74 bevacizumab, 167 ranibizumab) were reviewed. All injections were performed in an office-based setting. Povidone–iodine, topical antibiotics, and eye speculum were used as part of the pre injection procedure. Vision and intraocular pressure were evaluatedimmediately following each injection.
Main outcome measures: Incidence of post injection complications, including but not limited to endophthalmitis, retinal detachment, traumatic cataract, and vitreous hemorrhage.
Results: There were no cases of endophthalmitis, toxic reactions, traumatic cataracts, retinal detachment, or vitreous hemorrhage. There was one case each of lid swelling, transient floaters, retinal pigment epithelial tear, corneal edema, and corneal abrasion. There were five cases of transient no light perception following pegaptanib injections.
Conclusion: The incidence of serious complications was very low for the intravitreal injections given. A surgeon’s initial intravitreal injections may be performed with a very high degree of safety using this protocol.
Keywords: intravitreal injection, post injection complications, intraocular disease, age-related macular degeneration, bevacizumab, endophthalmitis, pegaptanib, ranibizumab
Olson R, Donnenfeld E, Bucci Jr F, Price FW, Raizman M, Solomon K, Devgan U, Trattler W, Dell S, Wallace RB, Callegan M, Brown H, McDonnell PJ, Conway T, Schiffman RM, Hollander DA,
Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery
Clin Ophthalmol 2010: 4; 1505–1514.
Purpose: The purpose of this study is to characterize the bacterial flora of the ocular and periocular surface in cataract surgery patients and to determine the prevalence of methicillin resistance among staphylococcal isolates obtained from health care workers (HCWs) and non-HCWs.
Methods: In this prospective, multicenter, case series study, eyelid and conjunctival cultures were obtained from the nonoperative eye of 399 consecutive cataract patients on the day of surgery prior to application of topical anesthetics, antibiotics, or antiseptics. Speciation and susceptibility testing were performed at the Dean A. McGee Eye Institute. Logistic regression was utilized to evaluate whether any factors were significant in predicting the presence of methicillin-resistant staphylococcal isolates.
Results: Staphylococcus epidermidis (62.9%), followed by S. aureus (14.0%), was the most frequently isolated organism. Methicillin-resistant S. epidermidis accounted for 47.1% (178/378) of S. epidermidis isolates, and methicillin-resistant S. aureus accounted for 29.5% (26/88) of S. aureus isolates. Methicillin-resistant staphylococcal isolates were found in 157 of 399 (39.3%) patients, the majority (89.2%) of whom were non-HCWs. The likelihood of being colonized with methicillin-resistant organisms increased with age (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.02–1.58; P = 0.04) but decreased with diabetes (OR, 0.51; 95% CI: 0.29–0.89; P = 0.02). Being a HCW (OR, 1.25; 95% CI: 0.61–2.58; P = 0.54) was not a risk factor for colonization with methicillin-resistant organisms.
Conclusion: Patients without exposure to health care environments are as likely as HCWs to be colonized with methicillin-resistant organisms. Increasing methicillin resistance with age may partially explain the increased risk of endophthalmitis reported with older age.
Keywords: age, bacterial flora, cataract surgery, methicillin resistance, ocular and periocular surface, Staphylococci
SETEMBRO/OUTUBRO 2010
Barreau G, Robert PY, Adenis JP
Intérêt de l’antibioprophylaxie par céfuroxime intracamérulaire dans la chirurgie de la cataracte
Réalités ophtalmol 2010; 175: 55-58.
“According to the most recent data, the percentage of endophthalmitis, using current prophylactic measures, is between 0.0088% and 0.38%.
Among all of the prophylactic measures studied until today, the two of them have demonstrated their interest and have been recommended, that is to say presurgical desinfection of the site using povidone iodine 5% and the use of topical antibiotics until healing, in practice until 5 days after sur-gery.
According to studies, injection of intracamerular cefuroxime at the end of cataract surgery enables a decrease of the risk factor of endophthalmitis of 5 to 10.”
The solution used by most of teams contains 1000mg of antibiotic.
After dilution of 10% using BSS, 0.1 ml (1 mg of cefuroxime) are injected in intracamerular with a tuberculin syringe and a Rycroft needle.”
Haque RM, Torkildsen GL, Brubaker K, Zink RC, Kowalski RP, Mah FS, Pflugfelder SC.
Multicenter open-label study evaluating the efficacy of azithromycin ophthalmic solution 1% on the signs and symptoms of subjects with blepharitis.
Cornea 2010; 29 (8): 871-7.
Abstract
PURPOSE: To evaluate the effect of 4 weeks of treatment with azithromycin ophthalmic solution 1% on eyelid bacterial load, tear cytokines, and signs and symptoms of blepharitis.
METHODS: Twenty-six subjects (mean age 64.2 years; 65% female; 100% white) with moderate to severe blepharitis received azithromycin ophthalmic solution 1% in the absence of warm compresses or eyelid scrubs for 28 days (twice a day on days 1 and 2 and once a day on days 3-28). Blepharitis signs and symptoms were evaluated at baseline (day 1) and compared with end of treatment (day 29) and 2 follow-up visits (2 and 4 weeks posttreatment). Tear collection and eyelid margin bacterial cultures were performed at baseline and end of treatment. Tear cytokines were measured by a multiplex immunobead assay.
RESULTS: Four-week azithromycin treatment demonstrated significant decreases from baseline in investigator-rated signs of meibomian gland plugging, eyelid margin redness, palpebral conjunctival redness, and ocular discharge (P < or = 0.002) at day 29, which persisted 4 weeks posttreatment (P < or = 0.006). Subject-reported symptoms of eyelid itching, foreign body sensation/sandiness/grittiness, ocular dryness, ocular burning/pain, and swollen/heavy eyelids also demonstrated significant im-provement from baseline (P < 0.001 for all symptoms and time points, except P = 0.037 for ocular dryness at visit 4). Eyelid margin culture exhibited significant decreases in coagulase-negative staphy-lococci and Corynebacterium xerosis bacteria. Changes in tear cytokine concentrations were not ob-served. Twelve subjects experienced 19 adverse events, 15 of which were ocular and none of which were serious.
CONCLUSIONS: Azithromycin provided significant improvement in signs and symptoms of blephari-tis after 4 weeks of treatment compared with baseline and persisted in the 4-week follow-up period.
Virgan
Hlinomazová Z, Loukotová V, Horáčková M, Serý O.
The treatment of HSV1 ocular infections using quantitative real-time PCR results.
Acta Ophthalmol. 2010 Jun 10. [Epub ahead of print]
Abstract
Purpose: Herpes stromal keratitis is a serious condition and the most frequent cause of uni-lateral blindness. The real-time PCR is an accurate and fast diagnostic method for an analysis of infec-tious agents causing keratitis and keratouveitis. The aim of the study was to assess the relationship between clinical symptoms, treatment efficacy monitoring and viral quantity in corneal swabs deter-mined by quantitative real-time PCR method. The real-time PCR method was used as well for the de-tection of other viral eye pathogens.
Methods: A total of 212 patients (136 men and 76 women) suspect of having herpes simplex virus (HSV) keratitis or keratouveitis were included in the study. The detection and quantitative analysis of the viral DNA were performed using the EliGene HSV1 RT kit, and the result was correlated with the clinical picture of the disease. The patients were routinely treated with acyclovir applied locally or, alternatively, in systemic administration. In a case of acyclovir treatment resistant keratitis, the patients were treated with local ganciclovir (Virgan gel ophth 0.15%).
Results: A total of 636 analyses of the viral DNA were performed; 85 patients were positive for HSV1 (198 detected). There were 16 acyclovir resistant cases of keratitis (14%).
Conclusions: The real-time PCR appears as a fast and accurate method for an exact identification of the viral DNA in patients with herpes stromal keratitis. The introduction of the quantification is important for the treatment evaluation and for the specification of a so-called acyclovir resistant keratitis. A long-term systemic administration in maintenance doses may lead to the resistance and repeated, frequent relapses of the disease.
Drew R. Chronister, Kowalski RP, Mah FS, Thompson PP
Independent In Vitro Comparison of Povidone Iodine and SteriLid®
Pharmacol Ther 2010; 26 (3): 277-280.
Abstract
Aim: Povidone iodine (PI) and SteriLid® (SL) are biocides used to decrease bacterial load on the eyelid margin. We compared the antibacterial activity of PI and SL to determine the better antiseptic.
Methods: Time-kill studies of PI and SL against a battery of bacteria that included Staphylocococcus epidermidis, methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Bacillus cereus, Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, and Branhamella catarrhalis were conducted at time points 1, 2, 10, and 30min. The comparative outcome measures were based on 90% and 99.9% decreases in bacterial colony counts.
Results: PI was more effective at a 90% kill than SL at time points, 1min (8/9 vs. 7/9), 2min (9/9 vs. 6/9), 10min (9/9 vs. 8/9), and 30min (9/9 vs. 8/9). PI was more effective at a 99.9% kill than SL at time points, 1min (5/9 vs. 3/9), 2min (7/9 vs. 4/9), 10min (9/9 vs. 4/9), and 30min (9/9 vs. 6/9).
Conclusions: Our study supports PI as an effective antiseptic for decreasing the bacterial load that can exist on the eyelid margin. SL appears to be a less effective alternative.
Chee SP, Jap A.
Cytomegalovirus anterior uveitis: outcome of treatment.
Br J Ophthalmol 2010 Jun 24. [Epub ahead of print]
Article sous presse.
Abstract
Aim: To determine the outcome of antiviral treatment of cytomegalovirus (CMV) anterior uveitis.
Methods: A retrospective review of patients from Singapore National Eye Centre with CMV anterior uveitis diagnosed by aqueous polymerase chain reaction. Ganciclovir treatment consisted of systemic, topical, intravitreal injections or intravitreal implant. The main outcome measure was resolution of anterior chamber inflammation.
Results: 72 eyes of 70 patients were positive for CMV DNA. 35 eyes were treated (23 eyes with acute recurrent anterior uveitis and 12 eyes with chronic anterior uveitis). Eyes that did not respond or recurred with one treatment may receive another course of treatment. There were 47 treatment episodes, 36 (76.6%) of which resulted in a response. However, there were 27 (75.0%) episodes of recurrences after stopping treatment. Systemic and intravitreal ganciclovir and ganciclovir implant had good response rates but also had very high recurrence rates. Ganciclovir gel had moderate response rates, but its recurrence rates were also lower than those of the other modalities.
Conclusions: Ganciclovir gel had lower recurrence rates than the systemic ganciclovir and the implant and should be considered as an option for treatment of CMV anterior uveitis.
Almeida DR, Miller D, Alfonso EC.
Anterior chamber and vitreous concordance in endophthalmitis: implications for prophylaxis.
Arch Ophthalmol 2010; 128 (9): 1136-9.
Abstract
OBJECTIVE: To examine the relationship between anterior chamber (AC) sterilization and vitreous positivity rate in cases of endophthalmitis.
DESIGN: Retrospective case-control study. A review of all consecutive cases of endophthalmitis (N = 758) between January 1, 1999, and December 31, 2008, identified 229 matched AC and vitreous sam-ples. Matched samples were evaluated for sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios. The main outcome measures were sensitivity and specificity of AC and vitreous samples in cases of endophthalmitis. Antibiotic resistance profiles from culture-positive endophthalmitis cases are given.
RESULTS: Gram-positive organisms accounted for 124 of 154 (80.5%) culture-positive endophthalmitis isolates (146 of 229 [63.8%]). The sensitivity (0.36%) and specificity (0.71%) of AC culture results were poor predictors of positive vitreous culture. Positive and negative predictive values were less than 60%. Positive likelihood ratio (1.24) and negative likelihood (0.91) of AC culture results did not aid in predicting vitreous findings. Gram-positive isolates demonstrated in vitro resistance to moxifloxacin (47.1%), ciprofloxacin (43.4%), gatifloxacin (36.8%), levofloxacin (29.0%), gentamicin (19.2%), and ceftazidime (16.7%).
CONCLUSIONS: The AC lacks concordance with vitreous findings in cases of endophthalmitis. Use of broad-spectrum antibiotics to sterilize the ocular surface and provide therapeutic levels in the AC may not prevent endophthalmitis. In this study, the finding of a sterile AC did not rule out vitreous infection. These results may have implications for the routine use of broad-spectrum antibiotics as a means of vitreous protection and endophthalmitis prophylaxis.
JUNHO/JULHO/AGOSTO 2010
Shah VM, Tandon R, Satpathy G, Nayak N, Chawla B, Agarwal T, Sharma N, Titiyal JS, Vajpayee RB.
Randomized clinical study for comparative evaluation of fourth-generation fluoroquinolones with the combination of fortified antibiotics in the treatment of bacterial corneal ulcers.
Cornea 2010; 29 (7): 751-757.
PURPOSE: Comparative evaluation of efficacy of monotherapy with moxifloxacin (0.5%) or gatiflox-acin (0.3%) with combination therapy of cefazolin (5%) and tobramycin (1.3%) in treatment of bacte-rial corneal ulcers.
METHODS: Patients diagnosed with bacterial keratitis (ulcer diameter 2-8 mm) were randomized to 1 of the 3 treatment groups (tobramycin 1.3% and cefazolin 5%, gatifloxacin 0.3%, or moxifloxacin 0.5%). After obtaining corneal scrapings, assigned study medication was instil-led hourly for 48 hours and tapered as per clinical response. Healing of ulcer, duration to cure, adverse reactions, antibiogram profile, treatment failures, final visual acuity, and corneal opacity size were evaluated.
RESULTS: A total of 61 patients were enrolled [cefazolin and tobramycin (n = 20), gati-floxacin (n = 21), and moxifloxacin (n = 20)]. Overall, 57 patients (93%) healed on treatment. On comparison of the mean time taken to heal, no statistically significant difference was found among all the 3 treatment groups (P = 0.98). Positive bacterial culture was obtained in only 38 patients (62%). There was no significant difference in the bacterial isolates in each treatment group. There were 4 (7%) treatment failures (perforation or nonhealing ulcer): 1 (5%) each in moxifloxacin and gatifloxacin group and 2 (10%) in fortified antibiotics group. All regimens were well tolerated.
CONCLUSION: The study failed to find a difference in the efficacy of monotherapy with fourth-generation fluo-roquinolones in the treatment of bacterial corneal ulcers of 2-8 mm size when compared with combina-tion therapy of fortified antibiotics.
Fernández-Rubio ME, Rebolledo-Lara L, Martinez-García M, Alarcón-Tomás M, Cortés-Valdés C.
The conjunctival bacterial pattern of diabetics undergoing cataract surgery.
Eye (Lond) 2010; 24 (5): 825-834.
PURPOSE: To ascertain the conjunctival bacterial pattern of diabetics undergoing cataract operation to reduce the risk of postoperative endophthalmitis (PE).
METHODS: An observational retrospective study of the conjunctival bacteria of consecutive patients undergoing cataract surgery from July 2005 to November 2008. Records of patients having eye surgical prophylaxis in the 6 months before the culture and those patients having cataract operation combined with other surgical procedures were ex-cluded. Aerobic and microaerobic cultures were carried out. Dade-Behring panels were used for bacte-rial identification. The database containing the isolated bacteria was linked to another Access database containing demographic and clinical data such as diabetes presence and baseline blood glucose and creatinine levels. The conjunctival bacteria of diabetics were compared with those of the non-diabetics. Epidat 3.1 program was used for statistical calculations.
RESULTS: From 5922 selected patients, 1325 (22.37%) knew they were diabetics (higher prevalence than expected). Among self-reported non-diabetics, 900 (15.2%) could be 'unknown' diabetics; another 274 had an impaired renal function; and 3423 non-diabetics joined the control group. Diabetics have a significantly higher prevalence of Staphylococcus aureus, Enterococci, certain Streptococci, and Klebsiella sp. than non-diabetics. Dia-betics and non-diabetics having a blood creatinine level above 105.2 mumol/l had an increased con-junctival bacterial prevalence; these groups had a higher mean age and men predominated.
CONCLUSIONS: Diabetics have a conjunctival flora pattern whose increased bacteria are a predominant cause of many diabetic infections. An abnormally high blood creatinine level is an indicator of increased conjunctival colonisation in diabetics and non-diabetics.
Tsai TH, Chen WL, Hu FR.
Comparison of fluoroquinolones: cytotoxicity on human corneal epithelial cells.
Eye (Lond) 2010; 24 (5): 909-917.
PURPOSE: To compare the cytotoxicity of different fluoroquinolones (FQs) towards human corneal epithelial cells (HCECs).
METHODS: HCECs were incubated with FQs (norfloxacin, ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, and gatifloxacin), both as commercial ophthalmic formulations and as unpreserved solutions. Cells incubated in different formulations of gentamicin, cefazolin, and benzalkonium chloride (BAC) were also compared. A cell viability assay, using 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay, was used to evaluate the drug effects on cell viability after five incubation times (30 min, 1 h, 4 h, 8 h, and 24 h). Transepithelial electrical resistance (TEER) was measured with a voltohmmeter to help understand changes in paracellular permeability at five time points (4 h, 8 h, 12 h, 24 h, and 48 h). Cell morphology was observed with an inverted fluorescence microscope, with multiple stage position and in time-lapse mode.
RESULTS: The preserving solutions and BAC at concentrations above 0.005% significantly decreased cell viability, when assayed by MTS. Increased paracellular permeability and decreased membrane integrity were also observed by TEER measurements and inverted fluorescence microscopy. Ofloxacin and levofloxacin were both free of preservatives and showed the least cytotoxicity towards HCECs in commercial FQ eye drops.
CONCLUSIONS: The cytotoxicity observed with FQ eye drops seems to be caused mainly by the preservative, which induced a significant decrease in membrane integrity and increased paracellular permeability. We found the new generation of FQs (moxifloxacin and gatifloxacin) no less cytotoxic towards HCECs than the old generation ones.
Furlanetto RL, Andreo EG, Finotti IG, Arcieri ES, Ferreira MA, Rocha FJ.
Epidemiology and etiologic diagnosis of infectious keratitis in Uberlandia, Brazil.
Eur J Ophthalmol 2010; 20 (3): 498-503.
PURPOSE: To study risk factors, microbiological characteristics, and clinical course of nonviral infec-tious keratitis diagnosed in a referral service of ophthalmology.
METHODS: A total of 65 charts of patients with microbial keratitis were retrospectively reviewed at the Clinical Hospital of Federal University of Uberlandia, Brazil, from July 2001 through August 2004. All cases were submitted to microbiological tests and treated according to local protocol. Risk factors, clinical course, therapeutic keratoplasty, and visual outcomes were analyzed.
RESULTS: The mean age of patients was 45.9 years (2-83 years) and male to female ratio 2.6:1. Symptoms at presentation ranged from 1-3 days in 16 patients out of 65 (24.61%), 4-7 days in 19 cases (19/65; 29.23%), and more than 7 days in 27 patients (27/65; 41.53%). The major risk factor was trauma (28/65; 40%), predominantly by organic material. A total of 32 eyes out of 65 (49.23%) were culture positive. Fungi were the most common isolates (18/32; 56.25%), being headed by Fusarium sp. (11/65; 16.92%), and the most common bacteria was Streptococcus pneumoniae (7/65; 10.77%). Final visual acuity was equal to or better than 20/60 in 20 patients out of 65 (30.77%), between 20/60 and 20/400 in 7 patients (7/65; 10.77%), and worse than 20/400 in 35 patients out of 65 (53.85%). A total of 48 eyes out of 65 (73.84%) presented corneal scar, 12 eyes (12/65; 18.46%) needed therapeutic penetrating keratoplasty, and 2 eyes (2/65; 3.08%) were eviscerated.
CONCLUSIONS: The high incidence of fungal keratitis in the studied population shows their vulnerability to such infections, which may result in devastating visual outcomes.
Chawla B, Agarwal P, Tandon R, Titiyal JS, Sharma N, Agarwal T, Navak N, Satpathy G.
In vitro susceptibility of bacterial keratitis isolates to fourth-generation fluoroquinolones.
Eur J Ophthalmol 2010; 20 (2): 300-305.
PURPOSE: To study the microbiological profile of bacterial keratitis in Northern India and to deter-mine the antibiotic sensitivity pattern of bacterial keratitis isolates to fourth-generation fluoroqui-nolones.
METHODS: Laboratory records of all consecutive cases of clinically suspected bacterial corneal ulcers were retrospectively reviewed. Data noted included microorganism isolated and antibiotic culture sensitivity to cefazolin, tobramycin, gatifloxacin, and moxifloxacin. In vitro susceptibility toward individual antibiotics was determined and compared with the potential in vitro susceptibilities to cefazolin-tobramycin, cefazolin-gatifloxacin, and cefazolin-moxifloxacin combinations.
RESULTS: A total of 292 bacterial isolates were identified. Of these, 255 (87.3%) were Gram-positive and 37 (12.7%) were Gram-negative. Staphylococcus epidermidis (n=227, 77.7%) was the most common organism. Overall susceptibility of isolates was 95.52% to gatifloxacin, 92.83% to moxifloxacin, 90.07% to tobramycin, and 83.56% to cefazolin (p<0.000). Organisms which showed resistance to fourth-generation fluoroquinolones included Staphylococcus epidermidis, Pseudomonas aeruginosa, viridans streptococci, Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli. Susceptibilities to gatifloxacin and moxifloxacin were comparable with each other (p=0.312) and with potential susceptibilities to cefazolin-tobramycin (p=0.479), gatifloxacin-cefazolin (p=0.134), and moxifloxacin-cefazolin (p=0.412) combinations.
CONCLUSIONS: Monotherapy with moxifloxacin or gatifloxacin can be an effective alternative to cefazolin-tobramycin combination as a first-line empirical therapy for bacterial keratitis. The addition of cefazolin to a fourth-generation fluoroquinolone is of limited value.
Nessa PJ, Mamalisa N, Wernera L, Maddulaa S, Davisa DK, Donnenfeld ED, Olsona RJ
An Anterior Chamber Toxicity Study Evaluating Besivance, AzaSite, and Ciprofloxacin
Article sous presse
Purpose: We determined whether Besivance (Bausch & Lomb), AzaSite (Inspire Pharmaceuticals, Inc; both with DuraSite bioadhesive [InSite Vision, Inc]) and ciprofloxacin are toxic inside the anterior chamber.
Design: Randomized, masked, placebo-controlled animal study.
Methods: Twenty New Zealand white rabbits (40 eyes) were randomized to 1 of 4 study groups: Besivance, AzaSite, ciprofloxacin, and balanced salt solution. Each eye was injected with 0.1 mL of the study medication. Clinical slit-lamp examinations were conducted at 24 and 48 hours after injection. All rab-bits then were killed and all eyes were enucleated. We randomized eyes to either corneal vital staining or histopathologic examination. The main outcome measures were clinical and pathologic signs of toxicity.
Results: The 2 DuraSite-based study groups (Besivance and AzaSite) showed clinically and pathologically sig-nificant differences when compared with the ciprofloxacin and balanced salt solution groups. Besiv-ance and AzaSite eyes exhibited significantly similar and severe clinical damage, including severe corneal edema. Ciprofloxacin and balanced salt solution eyes appeared very similar and had only mild conjunctival injection and limbal vascularity. Vital staining and histopathologic evaluation revealed glaucomatous and toxic damage in eyes given DuraSite-based medications, whereas non-DuraSite groups showed minimal changes.
Conclusions: DuraSite blocks the trabecular meshwork and may be additionally toxic when introduced as a large bolus. Until the safety of these medications is established with further studies using smaller injected volumes, we recommend placement of a suture over a clear corneal wound if DuraSite-based medica-tions are used.
Milazzo S, Brémond-Gignac D.
Une conjonctivite bactérienne de l’enfant.
Réflexions Ophtalmol 2010; 15 (135): 41-43.
Shirodkar AR, Flynn HW, Alliman K, Lalwani GA, Alabiad C, Moshfeghi AA, Miller D.
The comparison of clinical outcomes of endophthalmitis from fluoroquinolone-resistant and sus-ceptible bacteria.
Clin Ophthalmol 2010; 4: 211-214.
Abstract
PURPOSE: To identify patients who developed acute-onset endophthalmitis after clear corneal cataract surgery, and to compare treatment outcomes between cases caused by fluoroquinolone susceptible organisms versus fluoroquinolone resistant organisms.
DESIGN: Retrospective case series.
METHODS: Patients who developed endophthalmitis within six weeks of cataract surgery, and were treated between January 1996 and December 2008 at Bascom Palmer Eye Institute in Miami, Florida, were identified retrospectively. Clinical features, organisms cultured, and visual acuity outcomes were evaluated.
RESULTS: A total of 97 patients met study criteria, and 37 (38%) demonstrated in vitro fluoroquinolone resistance. All fluoroquinolone resistant endophthalmitis in the study was caused by either Staphylococcus epidermidis (n = 32) or Staphylococcus aureus (n = 5). Presenting clinical features were similar between fluoroquinolone resistant and fluoroquinolone susceptible groups. Final visual acuity was >/=20/40 in 49% of fluoroquinolone-resistant cases and 42% of fluoroquinolone-susceptible cases. All fluoroquinolone-resistant isolates were susceptible to vancomycin.
CONCLUSION: In the current study, approximately one-third of isolates were resistant to fluoroquinolones. There was no significant difference in clinical outcomes in this study, regardless of fluoroquinolone susceptibility.
Abad JC, Gomes JA, Guzzo G, Zaccarelli C.
Latin American consensus on antimicrobial prophylaxis in ocular surgery.
J Cataract Refract Surg 2010; 36 (5): 865-866.
Petitpas S, Robert PY.
Règles de prévention de l’endophtalmie.
Réalités Ophtalmol 2010; 173: 35-36.
ABRIL/MAIO 2010
Sauer A.
Prévention des complications infectieuses postopératoires et aspects médico-légaux.
Réflexions Ophtalmol 2010; 15 (134): 38-39.
- Bron A. Intérêt d’une antibiothérapie topique lors de la chirurgie de la cataracte. Page 38
- Kodjikian L. Précautions à prendre en 2010 pour une bonne prophylaxie dans la chirurgie de la cataracte. Page 38-39.
- Robert PY. Aspects médicaux-légaux dans la chirurgie de la cataracte. Page 39.
Kodjikian L, Lafuma A, Khoshnood B, Laurendeau C, Berdeaux G.
Efficacité de la moxifloxacine dans le traitement de la conjonctivite bactérienne aiguë : une méta-analyse.
J Fr Ophtalmol 2010; 33 (4): 227-233.
PURPOSE: To estimate the effectiveness of moxifloxacin instillation in the treatment of bacterial conjunctivitis. PATIENTS AND METHODS: Five randomized clinical trials on moxifloxacin were identified, three versus placebo, one versus ofloxacin, and another versus levofloxacin. The effectiveness parameters included clinical efficacy and drop-out rates for all reasons including lack of efficacy. The fixed and random effects were estimated on intent-to-treat populations. Models for risk ratios and risk differences as well as tests for study homogeneity were computed. RESULTS: Patients treated with moxifloxacin dropped out less frequently (OR=2.22 [1.62-3.03]; p<0.001), had less treatment failure (OR=3.61 [2.30-5.65]; p<0.001), and experienced clinical cure more often (OR=1.59 [1.21-2.04]; p=0.001) than placebo-treated patients. In comparison to ofloxacin, patients treated with moxifloxacin had fewer drop-outs for reasons other than treatment failure (OR=1.92 [1.28-2.89]; p=0.02) and fewer drop-outs for treatment failure (OR=2.53 [1.41-4.56]; p=0.002). CONCLUSION: This meta-analysis demonstrated the clinical efficacy of moxifloxacin compared to placebo. Fewer patients dropped out from moxifloxacin treatment compared to ofloxacin. Copyright 2010 Elsevier Masson SAS. All rights reserved.
MARÇO 2010
Marsal C, Ballonzoli L.
Données en antibiothérapie.
Réflexions ophtalmol 2010; 15 (132): 55-56.
Walters T, Rinehart M, Krebs W, Holdbrook M.
Tear concentration and safety of levofloxacin ophthalmic solution 1.5% compared with ofloxacin ophthalmic solution 0.3% after topical administration in healthy adult volunteers.
Cornea 2010; 29 (3): 263-268.
PURPOSE: This study evaluated the tear concentration and safety of levofloxacin ophthalmic solution 1.5%.
METHODS: Healthy adult volunteers (N = 125) received a single initial two-drop bilateral dose of either levofloxacin 1.5% (n = 100) or ofloxacin 0.3% (n = 25). Tear-fluid drug concentrations were measured at 15 minutes and at 2, 6, 12, and 24 hours after dosing. Subjects were dosed every 2 hours while awake and 4 and 6 hours after retiring (Days 1-3) and four times daily while awake (Days 4-14). Final measurements and evaluations were done on Day 15. Tear concentrations were determined by high-performance liquid chromatography. Safety and tolerability parameters included visual acuity, ophthalmoscopy, biomicroscopy, rose bengal staining, and adverse effects.
RESULTS: Tear concen-trations after a single two-drop dose of levofloxacin 1.5% and ofloxacin 0.3% were above 2 mi-crog/mL, a concentration that exceeds the minimum inhibitory concentration90 for levofloxacin in typical ocular bacterial pathogens at all time points through 24 hours. The area under the curve for the first 12 hours for levofloxacin 1.5% was 2703.5 +/- 574.22 microg.h/mL and 414.1 +/- 1179.00 mi-crog.h/mL with ofloxacin 0.3%. Maximal concentrations were 806.9 +/- 8.57 and 73.3 +/- 165.46 mi-crog/mL, respectively. Levofloxacin 1.5% and ofloxacin 0.3% did not differ in adverse event inci-dence, except for transient mild/moderate dysgeusia (14% of levofloxacin-treated subjects versus 4% of ofloxacin-treated subjects). No corneal epithelial damage or inflammatory changes were associated with levofloxacin.
CONCLUSION: A single dose of levofloxacin 1.5% produced tear fluid concentra-tions that were well above the minimum inhibitory concentration90 for typical ocular pathogens and was safe and well tolerated.
Creuzot-Garcher C.
Les conjonctivites folliculaires.
Cahiers Ophtalmol 2010; 138: 18-22
Les conjonctivites folliculaires constituent une pathologie fréquente qui peut survenir soit sur un mode aigu d’origine avant tout infectieuse ou chronique d’origine infectieuse, inflammatoire ou toxique. La principale cause de conjonctivite folliculaire dans le monde est le trachome alors que l’infection chlamydienne sous nos climats se traduit avant tout par une conjonctivite folliculaire chronique.
FEVEREIRO 2010
Miño De Kaspar H, Ta CN, Froehlich SJ, Schaller UC, Engelbert M, Klauss V, Kampik A.
Prospective study of risk factors for conjunctival bacterial contamination in patients undergoing intraocular surgery.
Eur J Ophthalmol 2009; 19 (5): 717-722.
PURPOSE: To determine whether a patient's age, gender, local or systemic risk factors affect the rate of preoperative bacterial contamination.
METHODS: Consecutive 1,474 patients undergoing intraocu-lar surgery were enrolled in this prospective masked study. Past medical history was noted and exami-nations were performed. The patients were divided into four groups: a control group (without local or systemic risk factors), those with local risk factors (chronic use of topical medications, contact lens wear, blepharitis, chronic eyelid or conjunctival inflammation), those with systemic risk factors (im-munosuppression, diabetes, autoimmune conditions, and asthma), and those with both. Conjunctival cultures were obtained before surgery.
RESULTS: Among the 1,474 patients, 914 bacteria were iso-lated from 214 (14.9%) patients. Advanced age was associated with a higher rate of positive conjunc-tival cultures (p<0.005). No statistical difference was found with regard to gender (p=0.7173). Among the 282 patients in the control group, 14 (5%) had a positive conjunctival culture. Compared to the control group, positive conjunctival cultures were found in 118 out of 503 patients (23.5%) with local risk factors (p<0.0001), 65 out of 545 patients (11.9%) with systemic risk factors (p=0.0019), and 22 out of 144 (15.3%) with both (p=0.0006). Two patients developed postoperative endophthalmitis (0.14%), one with both local risk and systemic factors and the other with a systemic risk factor.
CONCLUSIONS: Patients with local or systemic risk factors or advanced age were found to have a higher rate of bacterial conjunctival contamination before intraocular surgery.
Rautenbach P, Wilson A, Gouws P.
The reuse of opthalmic Minims: an unacceptable cross-infection risk?
Eye (Lond) 2010; 24 (1): 50-52.
AIMS: The instillation of a combined fluorescein-anaesthetic eye drop is common practice in most ophthalmology clinics. Chauvin Pharmaceuticals produce unpreserved proxymethacaine 0.5% and fluorescein 0.25% in a Minims vial (PFM) intended for single application only. Our aim was to deter-mine whether the reuse of these eye drops for multiple applications has the potential for bacterial transmission.
METHODS: Samples were collected from doctors in general outpatient clinics. Each sample constituted a blood agar plate inoculated with the initial drop of fluid from a PFM as a control. The vial was then used for multiple applications on consecutive patients. One of the last remaining drops was then inoculated onto an alternate marked site on the same plate to serve as the test sample. The samples were immediately transported to the Microbiology laboratory and incubated at 37 degrees C for 48 h. The results were interpreted thereafter by a Microbiologist.
RESULTS: A total of 41 sam-ples were collected by eight Samplers. In all, 7/41(17%) samples showed growth of normal conjunctiva and lid flora on the test area. These were coagulase negative Staphylococci and Corynebacterium spp.
CONCLUSIONS: The reuse of single application of PFM should be questioned due to the potential risk of transmitting pathogens. A change to a single use only policy would result in a projected threefold increase in the annual budget for these drops.
Reddy AK, Garg P, Alam MR, Gopinathan U, Sharma S, Krishnaiah S.
Comparison of in vitro susceptibilities of Gram-positive cocci isolated from ocular infections against the second and fourth generation quinolones at a tertiary eye care centre in South India.
Eye (Lond) 2010; 24 (1): 170-4.
PURPOSE: To compare the in vitro antimicrobial susceptibilities of Gram-positive cocci isolated from the ocular infections to the second and fourth generation fluoroquinolones at a tertiary eye care centre in south India.
METHODS: A retrospective review of microbiology records at LV Prasad eye institute, Hyderabad, India, identified 787 Gram-positive cocci isolated from different ocular infections between January 2005 to May 2008.The isolates were identified using culture characteristics and biochemical tests. In vitro antibiotic susceptibility of the isolates was determined by using Kirby-Bauer disc diffusion method. We analysed the susceptibility data of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin.
RESULTS: Out of 787 isolates, 147 (18.7%) were Staphylococcus aureus, 279 (35.2%) were coagulase-negative Staphylococci, 357 (45.4%) were Streptococcus pneumoniae,and 4 (0.4%) were other Streptococcus species. Of the four quinolones, susceptibility to gatifloxacin was highest (85.6%) followed by ofloxacin (65.6%), moxifloxacin (63.9%), and ciprofloxacin (60.5%). In all, 33 (4.2%) of 787 isolates were resistant to all the four fluoroquinoles. S. aureus and coagulase-negative Staphylococcus isolates that were resistant to ciprofloxacin and ofloxacin were most susceptible to gatifloxacin. S. pneumoniae were more susceptible to gatifloxacin, ofloxacin, and ciprofloxacin than moxifloxacin.
CONCLUSIONS: In our institute, we observed that gatifloxacin is more potent than moxifloxacin against Gram-positive cocci isolated from ocular infections.
Al-Mezaine HS, Al-Assiri A, Al-Rajhi AA.
Incidence, clinical features, causative organisms, and visual outcomes of delayed-onset pseudo-phakic endophthalmitis.
Eur J Ophthalmol 2009; 19 (5): 804-811.
PURPOSE: To report the incidence, clinical features, causative organisms, and visual outcomes asso-ciated with delayed-onset pseudophakic endophthalmitis.
METHODS: We retrospectively reviewed the clinical records and microbiology files of all patients with culture-proven endophthalmitis that was present 6 weeks or more after cataract extraction and posterior chamber intraocular lens (IOL) implan-tation who were treated at King Khaled Eye Specialist Hospital (KKESH) during a 10-year period.
RESULTS: From January 1997 through December 2006, 17 patients with culture-proven, delayed-onset pseudophakic endophthalmitis were treated at KKESH. Of the 17 cases, only 5 cases developed delayed-onset endophthalmitis, among 29,509 cataract surgeries performed at KKESH, indicating an incidence rate of 0.017% (5/29,509). The mean time between cataract surgery and diagnosis of endophthalmitis was 5+/-2.48 months. The culture isolates revealed Propionibacterium acnes in 7 (41.2%) eyes, polymicrobial (mixed) infections in 3 (17.6%) eyes, Staphylococcus species in 3 (17.6 %) eyes, fungal infections in 3 (17.6%) eyes, and Alcaligenes xylosoxidans in 1 (5.9%) eye. The mean follow-up period was 29.8 months. The final visual outcomes were as follows: 7 eyes (41.2%) achieved a final best-corrected visual acuity of >or=20/60; 6 eyes (35.3%) achieved a best-corrected visual acuity of <20/60 to >or= count fingers; 2 eyes (11.8%) had hand motion to light perception vision; and 2 eyes (11.8%) were enucleated.
CONCLUSIONS: In this study, infection by P acnes was the most common cause of delayed-onset pseudophakic endophthalmitis and had the most favorable visual outcome, whereas fungal endophthalmitis had the worst visual prognosis.
Major JC Jr, Engelbert M, Flynn HW Jr, Miller D, Smiddy WE, Davis JL.
Staphylococcus aureus endophthalmitis: antibiotic susceptibilities, methicillin resistance, and clinical outcomes. Am J Ophthalmol 2010; 149 (2): 278-283.
PURPOSE: To investigate the antibiotic susceptibility and clinical outcomes of endophthalmitis caused by methicillin-sensitive Staphylococcus aureus (MSSA) versus methicillin-resistant (MRSA) S. aureus.
DESIGN: Retrospective, consecutive case series.
METHODS: Charts of 32 patients with culture-proven S. aureus endophthalmitis seen at the Bascom Palmer Eye Institute from January 1, 1995, through January 1, 2008, were reviewed. Antibiotic susceptibility profiles, identified using standard microbiologic protocols, and visual acuity at 1 and 3 months were the main outcome measures.
RESULTS: MSSA was recovered from 19 (59%) of 32 patients and MRSA was recovered from 13 (41%) of 32 patients. Causes included cataract surgery in 18 (56%) of 32 patients, endogenous in 5 (16%) of 32 patients, bleb association in 4 (13%) of 32 patients, pars plana vitrectomy and ganciclovir implanta-tion in 3 (9%) of 32 patients, and trauma in 2 (6%) of 32 patients. All isolates were sensitive to van-comycin. MSSA isolates were sensitive to all tested antibiotics, except one that exhibited fluoroquino-lone resistance. In the MRSA group, frequent resistance occurred with the fourth-generation fluoro-quinolones (moxifloxacin, 5 of 13 patients [38%]; gatifloxacin, 5 of 13 patients [38%]). The median presenting visual acuity was approximately hand movements for both MSSA and MRSA eyes. All eyes received intravitreal antibiotics. Pars plana vitrectomy was performed on 47% of MSSA and 61% of MRSA patients. A final visual acuity of 20/400 or better at 3 months was achieved in 59% of MSSA and 36% of MRSA patients (P = .5).
CONCLUSIONS: Although all MSSA and MRSA isolates were sensitive to vancomycin, fewer than half of MRSA isolates were sensitive to the fourth-generation fluoroquinolones. Visual acuity outcomes between MRSA and MSSA eyes were not significantly dif-ferent. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Huguet P, Bella L, Einterz E, Goldschmidt P, Bensaid P.
Trachoma mass treatment with azithromycin 1.5% eye drops in Cameroon: feasibility, tolerance and effectiveness. Br J Ophthalmol 2010; 94 (2): 157-160.
BACKGROUND/AIMS: An epidemiological study carried out in 2006 indicated the existence of a high prevalence of blinding trachoma in the Kolofata Health District, Far North Region, Cameroon. As a result, the national blindness control program of Cameroon instituted a trachoma elimination pro-gramme using the SAFE strategy.
METHODS: A campaign to treat the entire district population with azithromycin 1.5% eye drops was undertaken in February, 2008. To measure the effectiveness of treatment on the prevalence of active trachoma, two epidemiological studies were conducted on a re-presentative sample of children aged between 1 and 10 years. The first study was performed just prior to the treatment campaign and the second study was performed one year later.
RESULTS: The preva-lence of active forms of trachoma (TF + TF/TI) dropped from 31.5% (95%CI 26.4-37.5) before treat-ment to 6.3% (95%CI 4.1-9.6) one year after treatment; a reduction of nearly 80%. There were no re-ports of serious or systemic side effects. Tolerance was excellent. No treatment was interrupted.
CONCLUSION: Mass treatment with azithromycin 1.5% eye drops is therefore feasible, well tolera-ted, and effective.
Infectious keratitis in 204 586 LASIK procedures.
Llovet F, de Rojas V, Interlandi E, Martín C, Cobo-Soriano R, Ortega-Usobiaga J, Baviera J.
Ophthalmology 2010; 117 (2):232-8.
PURPOSE: To investigate the incidence, culture results, risk factors, and visual outcomes of infectious keratitis after LASIK, and examine treatment strategies. DESIGN: Retrospective study.
PARTICIPANTS: We included 107 613 patients who underwent LASIK at Clínica Baviera (Instituto Oftal-mológico Europeo, Spain) from September 2002 to May 2008.
METHODS: The medical records of post-LASIK patients (204 586 eyes) were reviewed to identify cases of infectious keratitis. Incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and final visual out-comes were recorded.
MAIN OUTCOME MEASURES: Incidence of post-LASIK infectious keratitis, culture results, response to treatment, and visual outcome.
RESULTS: Post-LASIK infectious keratitis was diagnosed in 72 eyes from 63 patients. Onset of infection was early (within 7 days after surgery) in 62.5% of cases. Cultures were positive in 21 of 54 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus epidermidis (9 cases). Immediate flap lifting and irrigation with antibiotics was performed in 54 eyes; late flap lifting was subsequently requi-red in 10 out of 18 cases initially treated with topical antibiotics alone. One case required flap amputation owing to flap necrosis. Final best spectacle-corrected visual acuity (BSCVA) was >or=20/20 in 38 cases (52.7%) and >or=20/40 in 67 cases (93.05%); final BSCVA was <20/40 in 5 cases (6.94%).
CONCLUSIONS: The incidence of post-LASIK infectious keratitis was 0.035% per procedure. Infectious keratitis after LASIK is a potentially vision-threatening complication. The appearance of infections in asymptomatic patients highlights the need for a proper schedule of follow-up appointments. Prompt and aggressive management of this LASIK complication with early flap lifting, scraping, culture, and irrigation with antibiotics is strongly recommended. Proper management can result in preserving useful vision.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright (c) 2010. Published by Elsevier Inc.
JANEIRO 2010
Artunay O, Yuzbasioglu E, Rasier R, Sengül A, Bahcecioglu H.
Incidence and management of acute endophthalmitis after intravitreal bevacizumab (Avastin) injection.
Eye (Lond) 2009; 23 (12): 2187-2193.
INTRODUCTION: The aim of this study was to report the incidence and management of acute endophthalmitis after intravitreal injection of Avastin (bevacizumab), and visual acuity outcomes of three eyes of three patients who developed acute endophthalmitis following intravitreal injection of Avastin.
METHODS: This clinical retrospective, non-comparative study included 3022 intravitreal injections of 1.25 mg bevacizumab consecutively performed for 1822 eyes with exudative age-related macular degeneration and other retinal diseases. Of 3022 injections, 1200 were reinjections. After clinical appearance of post-injection endophthalmitis, immediate intervention was performed, including injection of intravitreal antibiotics and early pars plana vitrectomy.
RESULTS: Three eyes of three patients with acute postoperative endophthalmitis were identified in the first week following in-travitreal injections of 1.25 mg bevacizumab. Among of these patients, two cases were culture-positive and one case was culture-negative. Compared with presenting visual acuities, all of three patients im-proved at the end of follow-up time. The overall incidence rate of post-injection culture-proven endophthalmitis was 0.066%.
DISCUSSION: Acute culture-proven endophthalmitis is still a potential complication of intravitreal bevacizumab injection (approximately 0.066%) despite using maximal sterile techniques. Acute post-injection endophthalmitis following intravitreal bevacizumab occurs rapidly and can result in severe loss of vision. Prompt recognition and treatment are key in maximizing outcomes in patients who developed endophthalmitis after intravitreal injection of bevacizumab.
Keenan JD, Eckert S, Rutar T.
Cost analysis of povidone-iodine for ophthalmia neonatorum prophylaxis.
Arch Ophthalmol 2010; 128 (1): 136-137.
Halachimi-Eyal O, Lang Y, Keness Y, Miron D.
Preoperative topical moxifloxacin 0.5% and povidone-iodine 5.0% versus povidone-iodine 5.0% alone to reduce bacterial colonization in the conjunctival sac.
J Cataract Refract Surg 2009; 35 (12): 2109-2014.
PURPOSE: To assess the effectiveness of adding topical moxifloxacin 0.5% to topical povidone-iodine 5.0% for preoperative reduction of bacterial recovery from the conjunctiva.
SETTING: Emek Medical Center, Afula, Israel.
METHODS: The study population comprised adult patients scheduled for elective intraocular surgery. Two hours before surgery, patients were randomly assigned to topical therapy with moxifloxacin 0.5% drops (study group) or normal saline drops (control group). Povidone-iodine 5% solution was also instilled in the conjunctival sac in both groups for 3 minutes immediately before surgery. Conjunctival cultures were obtained before prophylactic therapy and just before sur-gery. The major outcome measures were the rate of bacterial colonization and bacterial type in con-junctival cultures obtained after instillation of povidone-iodine and immediately before surgery.
RESULTS: Overall, 464 patients completed the study; there were 237 patients in the study group and 227 patients in the control group. Positive conjunctival cultures were obtained before prophylactic therapy in 91 patients (38%) in the study group and 94 patients (41%) in the control group and just before sur-gery in 10 patients (4%) and 6 patients (3%), respectively; neither difference was statistically signifi-cant. Coagulase-negative Staphylococcus was the most prevalent bacteria and was found equally in both groups.
CONCLUSIONS: Treatment with povidone-iodine 5.0% alone was effective in preopera-tive reduction of conjunctival bacterial colonization. Adding topical moxifloxacin 0.5% to povidone-iodine 5.0% had no significant effect on further reduction in the bacterial colonization rate.
Bertino JS.
Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics.
Clin Ophthalmol. 2009; 3: 507-21.
PURPOSE: This article reviews the effects of the increase in bacterial resistance on the treatment of ocular infections. DESIGN: Interpretive assessment.
METHODS: Literature review and interpretation.
RESULTS: Ocular bacterial infections include conjunctivitis, keratitis, endophthalmitis, blepharitis, orbital cellulitis, and dacryocystitis. Treatment for most ocular bacterial infections is primarily empiric with broad-spectrum antibiotics, which are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has re-sulted in a global increase in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics as well as some of the newer fluoroquinolones used to treat ophthalmic infections. Strategies for the prevention of the increase in ocular pathogen resistance should be devel-oped and implemented. In addition, new antimicrobial agents with optimized pharmacokinetic and pharmacodynamic properties that have low toxicity, high efficacy, and reduced potential for the devel-opment of resistance are needed.
CONCLUSIONS: New antimicrobial agents that treat ocular infec-tions effectively and have a low potential for the development of resistance could be a part of strate-gies to prevent the global increase in ocular pathogen resistance.
